Dr Reichert on Investigating Novel Agents and Pathways in Prostate Cancer

Zachery Roger Reichert, MD, PhD, clinical associate professor, Internal Medicine, Hematology/Oncology, the University of Michigan Rogel Cancer Center, discusses the effects novel agents and pathways have had on the treatment of patients with prostate cancer.

Understanding how to match the biology of a patient’s individual prostate cancer with their overall disease type is important, Reichert begins. Additionally, it is imperative to design clinical trials that help researchers learn as much as possible about the biology of the investigational therapies to then determine the patients who are most likely to benefit from a specific treatment, he explains. For instance, treating every patient with prostate cancer with docetaxel (Taxotere) with no upfront consideration of which patients are most likely to benefit from this approach is now an outdated strategy, Reichert emphasizes.

Research efforts are revealing more about the known heterogeneity of prostate cancer. The heterogeneity of this disease allows some patients to live for 10 years with a hormone therapy alone, while causing others to progress within 6 months, he expands. Now that researchers can interrogate prostate cancer heterogeneity by evaluating mutations and gene rearrangements, these abilities open new investigational avenues, Reichert adds. All these mutations and rearrangements typically work through the pathways of RNA expression, protein expression, protein half-lives, and epigenetic regulation. Therefore, Reichert believes that descriptions of prostate cancer biology have been limited by the technology to describe that biology.

More advanced technology can help determine which patients will benefit the most from targeted therapies, Reichert continues. For example, PARP inhibitor decision making has evolved over the past few years, Reichert says. Although researchers have determined some of the patients who are likely to benefit from PARP inhibitors, stratifying patient populations into smaller groups and integrating data may reveal additional cohorts that can show which patients are truly benefiting from these therapies, he concludes.